依达拉奉联合醒脑静治疗成人急性脑梗死疗效的系统评价

目的系统评价依达拉奉联合醒脑静治疗成人急性脑梗死的有效性和安全性。方法计算机检索PubMed、EMbase、Cochrane图书馆、CBM、CNKI、VIP和WanFang Data,检索时限均为建库至2012年3月,查找依达拉奉联合醒脑静治疗成人急性脑梗死的随机对照试验(RCT)。按照纳入与排除标准,由两位研究者独立进行文献筛选、资料提取和方法学质量评价后,采用RevMan 5.0软件进行Meta分析。结果最终纳入9个RCT,共计1 098例患者。Meta分析结果显示,依达拉奉联合醒脑静组在有效率OR=3.43,95%CI(2.44,4.82),P<0.000 01]、显效率OR=2.33,95%CI(1.78,3.05),P<0.000 01]、病死率OR=0.38,95%CI(0.15,0.95),P=0.04]和治疗后ESS评分治疗后7天:SMD=–0.48,95%CI(–0.80,–0.17),P=0.003;治疗后14天:SMD=–0.89,95%CI(–1.17,–0.62),P<0.000 01;治疗后1月:SMD=–0.89,95%CI(–1.20,–0.59),P<0.000 01]及NDS评分治疗后7天:MD=10.42,95%CI(4.78,16.05),P=0.000 3;治疗后14天:MD=13.82,95%CI(12.86,14.79),P<0.000 01;治疗后21天:MD=10.33,95%CI(4.43,16.23),P=0.000 6]方面均优于单用醒脑静组,其差异均有统计学意义。依达拉奉+醒脑静+常规治疗组在有效率OR=3.03,95%CI(1.36,6.73),P=0.006]、显效率OR=2.86,95%CI(1.50,5.44),P=0.001]和治疗后ESS评分治疗后7天:MD=–6.26,95%CI(–8.49,–4.03),P<0.000 01;治疗后14天:MD=–6.43,95%CI(–8.73,–4.13),P<0.000 01]方面均优于常规治疗组,其差异有统计学意义。结论依达拉奉联合醒脑静治疗成人急性脑梗死疗效明显优于单用醒脑静及常规治疗。但由于纳入研究的方法学质量不高,上述结论尚需更多高质量、大样本RCT进一步验证。

Effectiveness of Edaravone Combined with Xingnaojing Injection for Adult Acute Cerebral Infarction： A Systematic Review

Objective To evaluate the effectiveness and safety of edaravone combined with Xingnaojing injection in the treatment of adult acute cerebral infarction. Methods Databases including PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data were searched from inception to March 2012 to identify the randomized controlled trials （RCTs） on edaravone combined with Xingnaojing in）ection for adult acute cerebral infarction. Two reviewers in- dependently selected the literature, extracted the data and assessed the methodological quality of the included RCTs, and then meta-analysis was performed using RevMan 5.0 software. Results A total of 9 RCTs involving 1 098 patients were included. The results of meta-analyses showed： a） The edaravone combined with Xingnao）ing injection group was su- perior to the Xingnaojing injection group with significant differences in the effective rate （OR=3.43, 95%CI 2.44 to 4.82, P〈0.000 01）, significantly-effective rate （OR=2.33, 95%CI 1.78 to 3.05, P〈0.000 01）, mortality （OR=0.38, 95%CI 0.15 to 0.95, P=0.04）, ESS score after treatment （7 days after treatment： SMD= -0.48, 95%CI -0.80 to -0.17, P=0.003; 14 days after treatment： SMD=-0.89, 95%CI -1.17 to -0.62, P〈0.000 01; 1 month after treatment： SMD=-0.89, 95%CI -1.20 to -0.59, P〈0.000 01） and NDS score after treatment （7 days after treatment： MD=10.42, 95%CI 4.78 to 16.05, P=0.000 3; 14 days after treatment： MD=13.82, 95%CI 12.86 to 14.79, P〈0.000 01; 21 days after treatment： MD=10.33, 95%CI 4.43 to 16.23, P=0.000 6）; and b） The edaravone ＋ Xingnao）ing injection ＋ conventional therapy group was superior to the conventional therapy group with significant differences in the effective rate （OR=3.03, 95%CI 1.36 to 6.73, P=0.006）, significantly-effec- tive rate （OR=2.86, 95%CI 1.50 to 5.44, P=0.001） and ESS score after treatment （7 days after treatment： MD= -6.26, 95%CI -8.49 to -4.03, P〈0.000 01; 14 days after treatment： MD=-6.43, 95%CI -8.73 to -4.13, P〈0.000 01）. Conclusion Current evidence shows edaravone combined with Xingnaojing injection is obviously superior to either Xingnaojing injection or conventional therapy for adult acute cerebral inf：arction. But this conclusion still needs to be further proved by more high- quality and large-scale RCTs because of the low quality of the included studies,